Crohn’s Disease aka regional enteritis
Feb 24, 2016
Crohn’s Diseaseaka regional enteritis
Overview of Presentation
General historical background information Description of the condition Management of the Disease Nutrition’s role in stabilizing the condition Conclusion
Ethical dilemmas (M.D. vs Nutritional) Opinion for managing the disease What the audience should know
The naming of regional enteritis• First Chief of Gastroenterology at Mount
Sinai in New York. Practiced medicine until he was 90.
• 1932 Crohn, with two colleagues, described a series of pateints with inflammation of the terminal ileum.
• Colleagues, Dr. Ginzburg and Dr. Oppenhimer, helped publish the seminal paper, “Terminal Ileitis: A new clinical entity”. Disease was known as regional ileitis upon publication.
• Believed the disease was caused by Mycobacterium paratuberculosis, which is responsible for a similar condition that afflicts cattle known as Johne’s disease. • Unable to isolate the pathogen-
undetectable under an optical microscope.
Dr. Burril Bernard Crohn
Inflammatory Bowel Disease
Behavioral Classification
•Stricturing•Penetrating•Inflammatory
Regional Tract ClassificationThree most common sites of intestinal involvement are:• Ileititis ~30% of cases• Ileocolic ~50% of cases• Colitis ~20% of cases• Gastroduoldenal and Jejunoileitis are
also common sites
Crohn’s Disease
Crohn's disease, also called regional enteritis, is a chronic inflammation of the intestines which is usually confined to the terminal portion of the small intestine, the ileum. Ulcerative colitis is a similar inflammation of the colon, or large intestine. These and other IBDs (inflammatory bowel disease) have been linked with an increased risk of colorectal cancer.
Anorectal fistulas
The lining of the intestine may ulcerate and form channels of infection, called fistulas. Fistulas tunnel from the area of ulceration, creating a hole which may continue until it reaches the surface of the organ, or the surface of nearby skin. These holes typically spread the infection that creates them, and life-threatening conditions such as peritonitis (inflammation of the lining of the abdomen) may occur.
Is it Crohn’s or Ulcerative Colitis?Crohn’s Disease Ulcerative
Colitis
Defecation Often porridge-like Often mucus-like and with blood
Terminal Ileium involved
Commonly Seldom
Colon involved Usually AlwaysFever Common Indicates severe
diseaseFistuleae Common SeldomWeight Loss Often More SeldomEndoscopy Deep snake like ulcers Continuous ulcer
Is it Crohn’s or Ulcerative Colitis?
Symptoms
Main symptoms include: Crampy abdominal pain Fever Fatigue Loss of appetite Pain with passing stool Diarrhea Weight loss
Other symptoms may include: Constipation Eye inflammation Fistulas Joint pain and swelling Mouth ulcers Rectal bleeding
Bloody stools Skin lumps or sores Swollen gums
What’s causing Crohn’s disease?
Mycobacterium paratuberculosis
Diet and stress Environmental stressors Autoimmune disorder
Who’s at risk for Crohn’s disease?
Younger than 30 Elevated risk for whites and
Eastern European Jewish descent
A close relative diagnosed Smokers Live in an urban area Live in a northern climate Diet high in fat or refined
foods
Bio-medical Interventions DIAGNOSIS
Colonoscopy most effective at detection (70%)
Endoscopy Blood tests
MEDICATIONS Anti-inflammatory drugs Corticosteroids Antibiotics
NUTRITION THERAPY Vitamin B-12 Iron Calcium Vitamin D
Bio-medical Interventions Surgery
Strictureplasty Colon restructure Colectomy Treat symptoms
Pros May lead to long-term
remission Cons
Disease often recurs
Trea
tmen
t
Diet & Lifestyle
Exclusion Diets Food Journal Avoid gas inducing
foods:High FiberDairyStimulantsSpicy High fat
Stop smoking
Do’s Drink lots of water Multi-vitamin and
mineral Anti-inflammatory foods
Fish oil Ginger
Raw foods Prebiotics Regular exercise Stress-relief activities
Don’ts
Vitamin Do Qualitative research on 57
yr. old womano Deficient while
supplimentingo Tanning bed for 10 min.,
3 times a week for 6 months at Boston University Med. Center
o Serum Vit D increase of 357%
o Maintained adequate levels 6 months later
o Hypovitaminosis D
Alternative Therapy
YogaTai ChiMeditationBiofeedbackSupport Groups
Ethical Dilemma – Food v. Medicine
Nutrition
Acute episodes often triggered by food
Poor absorption of nutrients requires intravenous feeding
No side effects from proper nutrition
Medicine
Strong, possible quick reduction of symptoms
Lots of negative side effects and adverse reacations
Only potent solution to potent problems
Conclussion
Treatment requires a multi-faceted approach
Support groups and experts necessary for proper educationBeware of snake-oil and testimonials
Get outside, get active, and gain control of your body
Need to know for the test How ulcerative colitis differs from Crohn’s
disease. Nutritional guidelines for patients with Crohn’s
disease. Most common areas affected by Crohn’s
disease. What’s the lesser known name for Crohn’s
disease. Possible causes of Crohn’s disease High risk categories Likelihood of contracting a IBD if family has
been diagnosed.
The End